Individual
DR. LEONARD Y WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
299 CAREW ST, SUITE 409, SPRINGFIELD, MA 01104-2301
(413) 734-3476
Mailing address
PO BOX 9135, BROOKLINE, MA 02446-9135
(603) 893-9784
(603) 893-8886
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
47835
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143863
—
MA
01
—
B33635
BLUE CROSS
MA
Enumeration date
09/14/2005
Last updated
03/10/2010
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